• Disability Claims and Family Medical Leave Act

    If you are a Dana-Farber patient or family member, you may decide to apply for disability or a leave of absence from your workplace, either because of your medical condition or to help a family member with his or her medical condition.

    As part of this process, you will need to complete paperwork when you file a claim for short- or long-term disability benefits from an insurance provider. You might also need this paperwork if you leave work under the Family Medical Leave Act (FMLA).

    Help with disability and FMLA claims

    In order to process your claim request, your insurance provider or employer will usually require disability and/or FMLA forms that include certain information from your Dana-Farber doctor or medical record.

    To complete a disability or FMLA form, please call Dana-Farber’s Health Information Services department at 617-632-2955. We will follow-up with your Dana-Farber doctor, and provide you and your insurance provider with all necessary information.

    What we need from you

    To ensure that we can process your disability or FMLA request in a timely manner, please follow these steps:

    1. Fill out and sign the Authorization for Release of Protected or Privileged Health Information form.
    2. Collect all disability or FMLA paperwork from your insurance provider or employer.
    3. Please fax, email, or mail your signed authorization form and insurance paperwork to Dana-Farber’s Health Information Services department:

      Health Information Services, Correspondence
      Dana-Farber Cancer Institute
      27 Dry Dock Ave., Fourth floor
      Boston, MA 02115
       

      Fax: 617-394-2647
      Email: Correspondence_ROI@dfci.harvard.edu 

    Questions?

    If you have questions or would like to check on the status of your request, please email Correspondence_ROI@dfci.harvard.edu or call Health Information Services at 617-632-2955.

    If you need a copy of your medical record for any other purpose, please see Medical Records.

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    • For adults:
      877-442-3324 (877-442-DFCI)
    • For children:
      888-733-4662 (888-PEDI-ONC)
    • Or complete the online form.